Prevalence, antimicrobial susceptibility patterns, serotypes and risk factors for group B streptococcus rectovaginal isolates among pregnant women at Kenyatta National Hospital, Kenya; a cross-sectional study

Abstract

Background: Estimates of Group B Streptococcus (GBS) disease burden, antimicrobial susceptibility, and serotypes in pregnant women are limited for many resource-limited countries including Kenya. These data are required to inform recommendations for prophylaxis and treatment of infections due to GBS. Methods: We evaluated the prevalence, antimicrobial susceptibility patterns, serotypes, and risk factors associated with rectovaginal GBS colonization among pregnant women receiving antenatal care at Kenyatta National Hospital (KNH) between August and November 2017. Consenting pregnant women between 12 and 40 weeks of gestation were enrolled. Interview-administered questionnaires were used to assess risk factors associated with GBS colonization. An anorectal swab and a lower vaginal swab were collected and cultured on Granada agar for GBS isolation. Positive colonies were tested for antimicrobial susceptibility to penicillin G, ampicillin, vancomycin, and clindamycin using the disk diffusion method. Serotyping was performed by latex agglutination. Logistic regression was used to identify factors associated with GBS colonization. Results: A total of 292 women were enrolled. Median age was 30 years (Interquartile range {IQR} 26-35) and a median gestational age of 35 weeks (IQR 30-37). Overall GBS was identified in 60/292 (20.5%) of participants. Among the positive isolates, resistance was detected for penicillin G in 42/58 (72.4%) isolates, ampicillin in 32/58 (55.2%) isolates, clindamycin in 14/46 (30.4%) isolates, and vancomycin in 14/58 (24.1%) isolates. All ten GBS serotypes were isolated, and 37/53 (69.8%) of GBS positive participants were colonized by more than one serotype. None of the risk factors was associated with GBS colonization.

Prevalence, Resistance Profile and Virulence Genes of Streptococcus agalactiae Colonizing Near-term Pregnant Women Attending Ain Shams University Hospital

“…On the other hand, El Aila et al 45 and Jisuei et al 66 detected reduced sensitivity of the isolates to vancomycin (76% and 80% respectively). In our study, GBS was 100% sensitive to levofloxacin.…”

Bacterial and Host Determinants of Group B Streptococcal Infection of the Neonate and Infant

“…However, antibiotic resistance is not restricted to ST-17 or other emerging hypervirulent complexes. Reduced sensitivity to many antibiotics, including penicillin G, ampicillin, clindamycin, and vancomycin has been detected in GBS-colonized pregnant women in Kenya, China, Ethiopia, South Korea, Brazil, Poland, and the United States ( Lu et al, 2014 ; Yoon et al, 2015 ; Mengist et al, 2017 ; Burcham et al, 2019 ; do Nascimento et al, 2019 ; Jisuvei et al, 2020 ; Kaminska et al, 2020 ). Erythromycin and clindamycin resistance have been observed in adult patients in a Taiwanese hospital ( Tsai et al, 2019 ), while penicillin and multidrug-resistant GBS were noted at multiple hospitals in Japan ( Nagano et al, 2012 , 2019 ).…”

Bacterial and Host Determinants of Group B Streptococcal Vaginal Colonization and Ascending Infection in Pregnancy

“…Unfortunately, a trivalent vaccine still does not include all clinically-relevant serotypes and could lead to selection of nonvaccine strains through capsule switching, a phenomenon that has been observed in many high-risk populations and among ST-17 strains (Bellais et al, 2012;Meehan et al, 2014;Neemuchwala et al, 2016;Nagano et al, 2019). Further, a recent study identified patients that were co-infected by multiple GBS serotypes at once (Jisuvei et al, 2020), which may enable capsule switching. Thus, a hexavalent CPS conjugate vaccine derived from serotypes Ia, Ib, II, III, IV, and V would cover more clinically-relevant strains (Bianchi-Jassir et al, 2020).…”